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Annals of Surgical Oncology

, Volume 22, Issue 4, pp 1324–1331 | Cite as

Aggressive Therapeutic Strategies Improve the Survival of Hepatocellular Carcinoma Patients with Performance Status 1 or 2: A Propensity Score Analysis

  • Chia-Yang Hsu
  • Po-Hong Liu
  • Yun-Hsuan Lee
  • Cheng-Yuan Hsia
  • Yi-Hsiang Huang
  • Yi-You Chiou
  • Ya-Ju Tsai
  • Teddy S. Nagaria
  • Teh-Ia Huo
Hepatobiliary Tumors

Abstract

Background

Targeted therapy or chemotherapy is suggested as standard treatment for hepatocellular carcinoma (HCC) patients with performance status (PS) 1–2 according to the Barcelona Clinic Liver Cancer (BCLC) system. The underlying rationales have not been fully studied.

Methods

This study enrolled 2,620 HCC patients. One-to-one matched pairs between HCC patients receiving aggressive anti-HCC treatments (resection, transplantation, ablation, and transarterial chemoembolization) and those receiving targeted therapy or chemotherapy or best supportive care were generated by using the propensity score with a matching model. Survival analysis was performed with the Kaplan–Meier method and the log-rank test. Mortality risk was calculated with the Cox proportional hazards model.

Results

Of 793 patients with PS 1–2, 64 % received aggressive anti-HCC treatments against the suggestion of the BCLC system. The patients receiving aggressive anti-HCC treatments had significantly milder cirrhosis, a smaller tumor burden, and better long-term survival than the patients undergoing targeted therapy or chemotherapy or best supportive care (all p < 0.05). With the use of propensity scores, 166 pairs of matched HCC patients with PS 1–2 were selected from different treatment groups. After matching, patients were comparable in age, gender, severity of cirrhosis, tumor burden, and prevalence of diabetes mellitus (all p > 0.05) at baseline. In the propensity score model, patients with PS 1–2 undergoing aggressive anti-HCC treatments had significantly better long-term survival (p < 0.0001). The adjusted hazard ratio of the choice for targeted therapy or chemotherapy or best supportive care to the choice for aggressive anti-HCC treatments was 2.028 (p < 0.0001).

Conclusions

According to the findings, HCC patients with PS 1–2 should consider aggressive anticancer treatments if no contraindication is noted. Adjustment of the BCLC treatment allocation is needed to enhance its prognostic accuracy.

Keywords

Sorafenib Propensity Score Tace Supportive Care Barcelona Clinic Liver Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This study was supported by Grants from the Center of Excellence for Cancer Research at Taipei Veterans General Hospital (DOH102-TD-C-111-007) in Taiwan, from the Taipei Veterans General Hospital (V103C-008) in Taipei, Taiwan, and from the Ministry of Education, Aiming for the Top University Plan (103AC-P618) in Taiwan.

Disclosure

None.

Supplementary material

10434_2014_4151_MOESM1_ESM.doc (39 kb)
Supplementary material 1 (DOC 39 kb)

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Chia-Yang Hsu
    • 1
    • 4
  • Po-Hong Liu
    • 1
    • 4
  • Yun-Hsuan Lee
    • 1
    • 7
  • Cheng-Yuan Hsia
    • 1
    • 5
  • Yi-Hsiang Huang
    • 2
    • 4
  • Yi-You Chiou
    • 1
    • 6
  • Ya-Ju Tsai
    • 8
  • Teddy S. Nagaria
    • 9
  • Teh-Ia Huo
    • 1
    • 3
    • 4
  1. 1.Faculty of MedicineNational Yang-Ming University School of MedicineTaipeiTaiwan
  2. 2.Institute of Clinical MedicineNational Yang-Ming University School of MedicineTaipeiTaiwan
  3. 3.Institute of PharmacologyNational Yang-Ming University School of MedicineTaipeiTaiwan
  4. 4.Division of Gastroenterology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
  5. 5.Department of SurgeryTaipei Veterans General HospitalTaipeiTaiwan
  6. 6.Department of RadiologyTaipei Veterans General HospitalTaipeiTaiwan
  7. 7.Department of MedicineYuanshan Branch of Taipei Veterans General HospitalI-LanTaiwan
  8. 8.Queen of Angels HospiceArcadiaUSA
  9. 9.Department of PathologyUniversity of TorontoTorontoCanada

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